Open Letter to the Medical Board of Australia: human rights violations in the proposed code of good medical practice

In August 2018, Miranda Devine, a journalist, let the world know that proposed changes had been made to the Australian doctors code of good medical practice. We discovered that submissions were called for but were closing in just a few days. Changes that were being proposed intended to even more thoroughly clamp down and limit freedom the doctors have as ordinary people to express in public. Interestingly, most doctors were not aware of the proposed changes that were being made.

Here follows the letter that I wrote to them in response to their call for general comments:

Dear Medical Board,

I’m writing in response to the proposed changes to the medical code of good medical practice. I am the first person to stand up and say that we need a code of good medical practice, one that equally supports us as doctors and people as patients.

I regret to say that the current code of good medical practice does not perform such a function in its existing role, nor its revised form and in fact the revised form raises even further concerns regarding the protection of the fundamental human rights that all doctors as people ought to have honoured. It is our duty as a profession to take care of the people in the profession and people who seek the support of the profession equally so, as whilst we consider people disparate and separate then we are not supporting the health and well-being of the all, and this is patently seen in the statistics of ill health and misery that affect the medical profession. We as doctors who know about the association of cause and effect and environmental medicine scientifically know that there is no such thing as truly random. We all know there are occupational hazards related to poor working conditions which include the entire systems that people work in. Doctors, too, as people are affected by the systems they work in and their ill health reflects the poor health of the systems they are in.

The Code of Good Medical Practice reflects such a system as it is a foundation by which doctors are investigated and prosecuted. Continue reading

Are doctors allowed to have freedom of speech? Or do we need to be thought policed?

hes got an opinion

Recently the code of practice of doctors proposed to restrict freedom of speech for doctors. Of course, such terms were not directly used in the proposition of the code, but in the newly introduced section of professionalism it stated that:

“Community trust in the medical profession is essential. Every doctor has a responsibility to behave ethically to justify this trust. The boundary between a doctor’s personal and public profile can be blurred. As a doctor, you need to acknowledge and consider the effect of your comments and actions outside work, including online, on your professional standing and on the reputation of the profession. If making public comment, you should acknowledge the profession’s generally accepted views and indicate when your personal opinion differs. Behaviour which could undermine community trust in the profession is at odds with good medical practice and may be considered unprofessional”

Where are the limitations in such a statement? And when is that possible, on twitter?!

When say, on twitter when discussing politics, or the finer principles of knitting or ironing – or football  – can we deliver the professions ‘generally accepted views’, and, why should we?

Who gets to determine the professions ‘generally accepted views’? And who should?

And since when does having a medical degree mean that you are no longer allowed to contribute to or participate in public debate unless it is ‘profession sanctified and sanctioned’?

Are we to now as professionals seek written permission from the board for any opinions that we have and espouse in public? On any topic? This is madness! And this is exactly what the wording of this section entails.

Freedom of speech is a fundamental human right that is available to everyone, and it is there for a reason.

Continue reading

Living with Heart in Medicine. Is it possible? Is it of benefit…

Living with heart in medicine adj.jpg

In medicine we are taught to think and live life from our heads.

We are taught facts and figures, and we are taught to be rational.

We are taught to approach things logically, from our heads, and we learn to relate to people from our heads.

We are perpetually analysing data, from our heads, and we end up talking from our heads.

There is a focus on mental acuity, mental strength and mental perspicacity.

But given that medicine is people and people love and care from their hearts, then where is the focus on connecting with people from our hearts?

We all know deep within that love and care for people is the foundation of medicine and healthcare. Its absolute bedrock.

When we are ill, we do not crave our mothers or fathers to speak to us with mental acuity, or to rattle off facts to us about the latest studies. We seek to be met with their hearts, with love and care. And deep down this is what we all seek. To be loved and to be and to feel cared for.

Given that medicine is about people, and at our core we all seek to be loved and to feel cared for, and this is a vital part of healing and feeling well – then why do we not make this a focus in medicine?

Where did the heart of medicine go?

Continue reading

Self-Care. Step 1 a.

Red Rosesadj

Step 1 with Self-care is knowing that you deserve to feel amazing, and that it is possible to feel amazing AND still do your job! In fact, even better than before 😉 Working in daily stress and tension is not a prerequisite to being a health care professional!

Yes our jobs can be stressful and there are aspects of the day that will challenge us from time to time, but there is no actual need for us to live daily in misery and tension and feeling unsupported.

Whilst there are many issues with the health care system that are yet to be rectified, the good news is that the power is still within us to make the changes towards well-being to empower ourselves to still feel well within the system. And then in time, of course the systems do need to change.

Feeling well is not about putting up with the systems the way that they are and accepting abuse, far from it.

Feeling well is not to please the administrators or the bureaucrats who are now exhorting us to ‘be resilient’ and ’put up’ with the failures and abuses in the system.

Feeling well is for us, because we deserve it and we are worth it.

Who doesn’t want to feel well?!

Step 1a is developing our quality.

Everything that we do in life comes with a certain quality. It is the quality of people that we feel and appreciate more than exactly what they do.

For example someone can yell at you “you are amazing’ but if they are saying it through gritted teeth and are angry at you, you will feel the deceit in the words.

If someone says with openness and love and care you are amazing, you will feel the warmth and the resonance in their words.

If someone touches you on the shoulder and it comes with control or is imposing, you will hate the touch, but if someone touches you with care and is unimposing, you will feel loved and amazing.

If someone helps you adjust your clothes, or tucks you into bed with cold rush and frustration you will feel it and you won’t feel cared for even though you are having something done to you that is supposedly caring. If someone does the same action with a caring presence you will feel cared for with that action.

Thus, it is the same with ourselves.

If we give ourselves food and it is rushed and just on the go, we will not feel cared for. It will be a functional empty exercise. But if we prepare our food in a way that is caring, and eat in a way that is caring of ourselves, then we will feel cared for.

Taking care of ourselves means taking care of ourselves in all aspects of our life, but it is the quality in which we do this that makes the biggest difference. Continue reading

Self-care. Where do I start?!

Daffodils adjThere is a growing buzz word on the streets that is ‘self-care’. We as doctors now need to ‘self-care’. But what exactly does that mean?!

When I speak to most people, they like me years ago don’t have a clear understanding on what it is to take care of ourselves.

When I speak with people about self-care their responses are usually, after a prolonged pause and thinking along the lines of:

‘Pampering yourself from time to time’

‘Making sure you eat healthy’

‘Knowing when your mental health is bad’

‘Having hobbies outside of medicine’

All those things are part of self-care, but they are not the all of what self-care is.

Most of us know that when we are ill, we need to take care of ourselves and get rest.

But what if we took care of ourselves all of the time?

Might that change the quality of life that we daily live in?

True self-care is not just about what we do to rescue ourselves when we are blue and down and out, but it is about taking care of ourselves in all aspects of our lives so that we lead amazing lives, feeling truly well.

In Medicine, our concept of life is that we survive life, that we survive the day, that we survive the week, and thus it makes sense that when we consider self-care that it is something that we do the bare minimum to make it through the day, the week and the year without dying.

But if we shift our focus and consider that we are here to live truly well in life, to thrive instead of survive, then that shifts our focus on the way we take care of ourselves.

The way that we feel comes from the way that we live life, in all areas of our life.

There is no one area of our lives that we can compartmentalise as being separate from any other aspect of life. We are the same body, literally, in all of life. We all know how stress at work can feed into and affect our home life, and vice versa. Thus self-care is about taking care of ourselves in all areas of life.

Self-care is not just doing the things that function, it is about the way that we do things with and for ourselves.

Self-care begins with a quality. Continue reading

Health Care Reform. When do we need it, and how?!

Burnout matchesFirst published in the European Medical Journal October 18 2017 I re-publish it here:

The buzz on the streets across the world is the need for healthcare reform. The costs of healthcare are exponentially skyrocketing globally and the rates of illness and disease are increasing, with mental health and chronic pain being in the top 5 causes of disease burden globally. Of the world’s population, 95% have some form of illness during the year; furthermore 81% of people with 5 or more health conditions are below the age of 65.1 The rising rates of chronic, non-communicable diseases across the planet are so rampant that the World Health Organisation (WHO) has labelled this as an epidemic.2

Globally, healthcare systems are struggling to cope with the burden of illness and disease they are faced with; the costs are expensive for healthcare organisations, governments, as well as consumers.

In today’s constrained financial times, the focus of healthcare reform has been on cost (including the cost of personnel) and how the cost will be sustained.

In the NHS, systems are stretched, with large numbers of staff leaving to work in lesser skilled roles for the same level of pay.3 The remaining staff are left in the tricky situation of coping with the high patient load with reduced numbers of colleagues.

In the USA, managed care has rationalised the delivery of healthcare with a focus on electronic health records for billable items, patient satisfaction, and business outcomes. This focus means professional autonomy has never been lower for healthcare professionals.

At the same time, the health and well-being of the medical professionals has reached an all-time low with burnout rates of more than 50%,rates of anxiety and high psychological distress greater than that of the general public,5 and suicide rates and suicidal ideation far higher than the general public.

The combination of these statistics highlights the potential difficulties associated with mental health faced by those in the medical profession and perhaps represents the tip of a growing iceberg.6 Continue reading

Self-care – who needs it?!

IMG_0093When I spoke with a group of medical students recently, I asked them what their understanding of self-care is and what it is in their lives. Their responses were as follows:

After a long period of consideration….

‘umm…..knowing when to take a break?’

‘….making sure you notice when your mental health is getting worse?’

‘…making sure you have hobbies outside of medicine to balance the stress so you don’t get too stressed?’

And their answers were phrased as questions more than direct confirmed answers. Like so many of us, they had no true concept of what it is to take care of ourselves.

Yet, looking after ourselves is a foundation in life. If we are not taking care of ourselves then how are we treating ourselves and why?

If we had a beautiful car, lets say a Lamborghini, or, a Maserati, we would treat it with care and pride.

We would make sure that we got it serviced frequently.

We would make sure it was cleaned and polished, and sparkling, regularly.

We would drive it with care, and enjoy the power in its manner of driving.

We would put the correct fuel in it, and regularly so.

We would make sure we didn’t do anything to injure it, a. because we loved it and b. because it would cost a lot to fix it if anything did happen to it!

But why don’t we have the same approach to our bodies?

How we treat our bodies has a big impact on the health and well-being of our bodies.

I find it interesting that in the health care profession in particular, that we are even less likely to take care of our bodies than in other professions.

In Medicine the culture is around studying until you drop, sleep deprivation as a sign of dedication to your studies and determination, and having food only on the go and only when you have to, or as a relief from the stress and tension of it all.

But in Medicine in particular we are here to be the leaders in health care, and health and well-being. Continue reading

What actually is personalised medicine?

doctor baby adj

The latest buzz word in health care is to make it ‘personalised’. This word I have noticed is used interchangeably with ‘precision’ medicine. Precision medicine is where drugs are ideally chosen to be used dependent on the genetic profile of each person. But this is hardly personalised! It may be precise, but it is definitely not the definition of personal.

When I consider the term ‘personal’, I consider the person and what it is to be a person.

There is far more to our make up as people than our genetic makeup! We are whole people with feelings, thoughts, sensitivities, dreams, aspirations, relationships, jobs, families, children and a whole host of assorted issues and personalities. There is far more to being a person than our genetics, our gender, and our anatomic arrangements!

Making something personal, means that we are cared for as a whole, that our uniqueness is taken into consideration, and that treatments are tailored for us as a person. As a whole person, not just a set of genes, organs and blood tests.

The notion of personalised means that things become exactly that. Personal. Where you connect with and develop a relationship with your doctor or other health care provider. Where you and your practitioner are seen and respected for the people that you are. Continue reading

What are we training medical students for?

depressed young doctor adjWhen young people go to medical school they are called medical students. They know that they are to learn about medicine. Everything about medical school is about learning about medicine. In fact, every waking moment is about learning about medicine.

We learn about anatomy, physiology, statistics, how to read a research paper, how to do a research project, we learn about diseases, pathology, histology, how to examine patients. We learn the right questions to ask in the right way to get the information that is needed.

We endlessly learn about rare diseases, treatment protocols and how to do various procedures and operations.

Our whole lives are consumed with medical information.

But is this all that there is to medical school?

Of what value is all the medical knowledge in the world if the person holding that knowledge is miserable and unwell themselves, struggling to work and struggling to cope with people?

Of what purpose is it learning everything that there is to learn about ‘medical knowledge’ if we are not preparing our students to be well in life? Continue reading

Who took the Fun. out of Medicine?!

Alex funny doctor adj

If you go to any health care conference all around you, you will see a bunch of very serious professionals. Dedicated to their cause, they are taking it very seriously. It is rare to see anyone laughing, and conversations about health care and research matters are taken very seriously. People get upset about things, and they express their hurts, and sometimes, people storm out of meetings. It can be intense!

It is the same on hospital wards and in consulting rooms. Doctors as a rule are a very serious group of people. We are trained to be that way. You need to look serious to be taken seriously, or so we learn.

But what kind of a way is this to live life?

In all seriousness (yes, yes, pun intended ;)) why can we not have fun at work?

Why can we not have fun and enjoy ourselves when we discuss things?

Does it all have to be SO serious and intense?

Do we have to look serious and intense to show that we are paying serious attention to things? To show that we care?!

I wonder,

What might happen if we kept things light?

What might happen if we saw the lighter side of things when things didn’t seem quite right to us in a discussion about a certain matter?

And what if we kept things light when somebody dared to disagree with our point of view, in public of all things! As everyone knows in academia, differing opinions can be the start of a very intense exchange…

Yet, when we are born and we are small, we know how to enjoy life. We know how to laugh, and how to enjoy ourselves. It’s usually not a disaster if we fall over and make our bottom a little bit wet……. Small children naturally laugh with each other, unless they have been traumatised…

Is this perhaps what happens to us in the medical profession?

I wonder, do we perhaps become traumatised through the way that we are educated and trained, and through our professional experiences and use being ‘serious’ as a coping mechanism?

Is this perhaps one of our modes of defence and protection from trauma, our serious faces projecting out against the traumas of the world, both actual and perceived?

And what do we think our professional seriousness will prevent… Continue reading